Sr Director of RCM Compliance & Quality

• Work with dynamic technology solutions that are constantly evolving to meet the needs of the healthcare industry.  

• Collaborate with a talented and passionate team of individuals who are dedicated to improving the lives of patients and healthcare providers.  

• Make a real impact on the healthcare industry by helping to improve the efficiency and quality of care.  

• Build a rewarding career with opportunities for growth and development.  

The Senior Director of RCM Compliance & Quality will provide operational leadership pertaining to compliance and regulatory issues enabling a comprehensive quality assurance program. The overlapping goals of Compliance and Quality serve to promote efficiency, accuracy and adherence to standards.  The Compliance aspects of this role require responsibility for interpreting and communicating all aspects of existing, proposed, and newly enacted federal and state rules and regulations relating to preventing healthcare fraud, waste and abuse.  And to align with Compliance standards, this role is also responsible for creating and monitoring Quality assurance programs that include documentation standards, client onboarding and engagement requirements, revenue cycle and practice "best practice" operations.  Job functions include and are not limited to: 

• Develop and maintain working knowledge of rules, and regulations that relate to healthcare practice and RCM operations, and health plans, their interpretation, current trends and issues, and timelines for compliance. Develop and update the Policy & Procedure onboarding process, to ensure adherence to rules and regulations relating to the RCM business.  Track and disseminate laws and regulations that affect the RCM organization's policies.  Provide ongoing education to ensure the RCM team is up-to-date with changes in healthcare regulations and industry trends. 
• Serve as the company’s subject matter expert on RCM healthcare compliance laws and regulations. Collaborate with clinical, data analytics, technical product and client teams and other stakeholders as needed, to identify and initiate improvements to ensure compliance with existing and evolving federal and state rules and regulations as they relate to RCM functions.  Participate in Enterprise leadership committees as indicated, including but not limited to Quality Management, Compliance, and others.
• Design and implement a comprehensive quality assurance framework, applying data-driven methodologies to establish benchmarks, identify quality gaps, and ensure continuous improvement.   Foster a culture of continuous improvement by promoting innovation and efficiency in all operational processes. 
• Oversee departmental and vendor workflow procedures as they relate to regulatory compliance.  Complete gap analyses for compliance with additions and changes to the standards, rules, and regulations and assesses potential organizational impact. Identify potential risks related to regulatory compliance, data security, and operational errors, and proactively implement strategies to mitigate these risks. 
• Lead Audit function in conjunction with other stakeholders to ensure compliance. Conduct or lead others in routine audits to uphold coding and billing standards.  Conduct root cause analysis on errors and implement preventive measures to minimize future risk. Manage and assist in the development, tracking and completion of corrective action plan.Lead and prepare investigations related to compliance and privacy issues in an accurate manner, notifying affected parties in a timely manner.  
• Contribute to team and/or vendors maintenance of a daily focus on attaining productivity standards or Service Level Agreement (SLA) metrics, recommending new approaches for enhancing performance and productivity within quality guidelines as appropriate; contribute to the management of client success team interactions and operations. Ensure all RCM processes and services meet legal, contractual, and accreditation requirements. 

• Other ad hoc activities and projects as assigned. 
  
  Qualifications:

• 15+ years background in all aspects of provider revenue cycle management, practice management
• 10+ years of people management experience
• Must possess strong working knowledge of CPT, ICD10, Appeals, Posting & Collections.
• Demonstrated ability in managing projects with multi-disciplinary teams, with exceptional relationship-building skills
• Ability to effectively speak with providers, vendors and employees, and all level of staff within the company and in large group settings such as webinars
• Practical work experience desired in client relations, implementation and support, process planning and improvement and KPI management; experience in leading RCM Compliance, Audit and Client Engagement functions
• Proficient in Microsoft Office (Excel, Word, PowerPoint, Outlook)
• Strong work ethic, well-spoken and professional
• Preferred certifications include Certified Professional Compliance Officer (CPCO), Certified Professional Medical Auditor (CPMA)
• Required to have worked at large-scale (more than 100 practices) RCM outsourcing company servicing independent physician practices, specialties preferred: chiropractic, behavioral/therapy and/or vision